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Home My WebLink About7362-zNO. & TOWBI OF $OUTHOLD BlJlI.BING DEPARTMF2~ Town Clerk's Oltiee $outhoM, BI. Y. Certificate Of Occupancy No. Z6192 Date NOV I, 19. ~.. R.O.#, - B/8 CUrD I(LnOObL Rd THIS CERTIFIES that the building located at .. P. rl['~l~.t.e..fi.o.e.d. I~..~.? ..... Street Map No..l~. .......... Block No....x:~. ...... Lot No.....x~.....~.a.t..t.:[..~.e..k...17 .,.~.,. ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. ~..~..'....~.., ~9..~.., wa.~ i.~s.ed, and conforms to ~U of the ~.~ ments of the applicable provisions of the law. The occupancy for which this certificate is issued is private &ccessor~ building v~.th ,n addition The certificate is issued to .(~..0..Z'.ge...L~..8.e.~l. ~.e ......... .1~..e? ......................... (owner, lessee or tenanf) of the aforesaid building. Suffolk County Department of Health Approval .lg.:~: ............................... UNDERWRITERS CERTIFICATE No.I~...R..· ........................................ HOUSE NUIvlBER ...~.0. ........ Street..l~'~c..I~1. ~..1~ ........................... ro~ ~o. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF TIdE WORK AUTHORIZED) ' N? 7362 Z Permission is hereby granted to: Ge~z, ge..~---~ee~.Ze ................. . .................. ............ · ~,~ .l~ ,i.~buek .............................................. to ..... ~u.~..~.~.a..n.~a..~.`$.~.L.~..~.~..n....e.x.L~.~.$~ug..~.~.e~a~.~r~b..~`L~ag ................................... at premises located at .....R.,4).,~;$~.....(.~.~...~....1.~.)...~./¢f]-.~$~q:)~ ...H~e~,J:a...R¢} ......................... ......................................................... -~a"b ~:~,~k' '"'},%'~ v ................................................................... pursuant to application dated ............................. ~.t~e...;~. ......... ,. 19.~L~.., and approved by the Building Inspector. Fee $.::J. 0 ~.C,:~ ........... Building inspector FORM NO. 6 TOWIq OF $OUTHOLD Building Department Town Clerks Office Southold, iq. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, sfreets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 New Building ................ ~d~on ...~ .......... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ..-:~-~J~..~..~..~..~k~..~..~.....~./~...q~m~...~!;..~e..~...z..~.g~..~.~..y.t~:~.~....z..~.~ Owner Or Owners Of Property ...Q...e..9..~.~.e..~.~.~'.~.~.~.~..~.~.~..~..e...~..1~..~..e.....~.~.*...`~. .~.P.9.~.~.~ .............................. Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No....?.].~.~ ........ Date Of Permit 6/.2.~/.~..¢...Applicant ~eoz~e ~f. ~asoelZe Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approv(~l .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final .Certificate ..... Z~ .................................. Fee Submitted $ 5.,D.Q .......................... Construction on above described building and pe,.rmit meets all ~apjj;zl)icable codes and regulations. Sworn to before me this ................ / ? //'r~, day ......................... : ................. ROBERT A. PARKIN Notary Rubhc, State of New York No. 52.8280300, Suffolk Cour]l:y Term Expires March 3~, 19,1~~. (stamp or seal) TOWN OF SOUT.OLD f BUILDING DEPARTMENT / /~ / ' ~ TOWN CLERIC'S OFFICE ~ - ~~ Examined , .~. Application No....~.....: ..................... ~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Thins application mUSt be completely filled in by typewriter ge in ink and submitted in triplicate to the Building Inspector, with 3 set~ of plans, accurate plot plan to ~ale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets o~ areas, and giving a detailed description of layout ofpropertymust be drawn on the diagram which is part of this applicatiork~ c. The work covered by this application may not be commenced before issuance of Building Permit. d./~pon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursu..ant to the Building Zone Ordinance of the Town of Southold, Suffolk County, N&9~ ]York, and other applicable Laws, Ordmancos or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Address.of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..................~.fjg.~L.e....~.~.....~...~.~o.~.~.]....e. ....................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No .................................. ./.. .......... Electrician's License No ......................... /.~ ................. Other Trade's License No ............................................... Location of land on which proposed work will be done. Map Ne.: ...0~ ............................... Lot No ......................... Street and Number -4~e-Priva~e Road 1~.~ M.a.t~i~uck, ~. ¥. ~'0 Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: 3. Nature of work (check which applicable): New Building .................. Addition ....~.. ............ Alteration ................. Repair .................. Removal .................. Demolitio~ .................... Other Work ................................................... (Description) 4. Estimated Cost ............................................................ Fee .......................................................................................... (to be paid on 'filing this application) 5. If dwelling, number of dwelling unit's ............................ Number of dwelling units on, each floor ........................... If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, s~ecify nature and extent of each type of use ............................ Height ...... ],2 .............. Number of Stories ..... 13.~.e ............................................................ ~ ....................................... Dimensions of same structure with alterations or additions: Front ..~.~.t.....6..~.T. ................... Rear ..~..6...~.....6..'.' ............ Depth .....2..2~.L...8..?. ............. Height ..~.~ ..................... Number of Stories ....... .Q~fl ................. 8. Dimensions of entire new construction: Front ...:L0.! .......................... Rear ..3,0.! ................... Depth ...~/. ................... Height 8~ Number of Stories 01'1e 10. Dote of Purchase ........................................................ Name of Former Owner 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. W, ill lot be regraded . ........................... Will excess fill be removed from premises: ( ) Yes ( ) No Name of Architect ........ ~,~.!.?.t..e.~ .......................................... Address ................................ Phone No ....................... Name of Contractor ............. ..q?..~.t.?.,?,. .................................. Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEWcY~ff/,~//O ~S S GOUNTY OF ....r,,~.t.:......._,~' ,~ ....................... ~~.~:.. ..................... being duly sworn, deposes and scsys that he is the applicam (N~(~ 6f individual signing contract) above named. He is the ..................................... ~ ........................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and Js duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and thor the work will be performed in ~t~e manner set forth in the application filed therewith. Sworn to before me this /'/